Publications by authors named "Rhonda Johnson"

37 Publications

Adaptation of the barriers to help-seeking for trauma (BHS-TR) scale: a cross-cultural cognitive interview study with female intimate partner violence survivors in Iceland.

J Patient Rep Outcomes 2021 Feb 27;5(1):22. Epub 2021 Feb 27.

School of Nursing, University of Michigan, Ann Arbor, MI, USA.

Background: Even though traumatization is linked to substantially reduced health-related quality of life, help-seeking and service utilization among trauma survivors are very low. To date, there has not been available in Iceland a culturally attuned, self-reported measure on help-seeking barriers after trauma. This study aimed to translate and cross-culturally adapt the English version of Barriers to Help-Seeking for Trauma (BHS-TR) scale into the Icelandic language and context.

Methods: The BHS-TR was culturally adapted following well-established and rigorous guidelines, including forward-backward translation, expert committee review, and pretesting through cognitive interviews. Two rounds of interviews with 17 female survivors of intimate partner violence were conducted using a think-aloud technique and verbal probing. Data were analyzed using qualitative content analysis, a combination of deductive and inductive approaches.

Results: Issues with the BHS-TR that were uncovered in the study were classified into four categories related to general design, translation, cultural aspects, and post-trauma context. The trauma-specific issues emerged as a new category identified in this study and included concepts specific to trauma experiences. Therefore, modifications were of great importance-resulting in the scale becoming more trauma-informed. Revisions made to address identified issues improved the scale, and the process led to an Icelandic version, which appears to be semantically and conceptually equivalent to the original version; additionally, the results provided evidence of content validity.

Conclusions: As a cognitive interview study, it adds to the growing cognitive interviewing methodology literature. Furthermore, the results provide essential insights into the self-report response process of trauma survivors, highlighting the significance of making health-related research instruments trauma-informed.
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http://dx.doi.org/10.1186/s41687-021-00295-0DOI Listing
February 2021

Ethical considerations for community-based participatory research with Sami communities in North Finland.

Ambio 2021 Jan 16. Epub 2021 Jan 16.

Montana State University, 318C Herrick Hall, Bozeman, MT, 59717-3540, USA.

This study examines the perspectives of Sami community members and university researchers regarding the ethical considerations for engagement in Community-Based Participatory Research (CBPR) with Sami communities in northern Finland. Key informant interviews were conducted with Sami people from Finland who were exposed to or participated in research in their communities as well as with researchers who have conducted research with the Sami in Finland across diverse topics. Five themes were identified: establishing trust, research preparation, research comprehension, research ethics, and inclusion in research. The differences in participant perspectives were compared based on their community versus researcher roles. Our findings emphasize the need for (1) strategies to develop and maintain trust between Sami communities and researchers; (2) methods to bridge concepts of bias projected onto Sami communities and researchers by the others' differing world views and beliefs about research; and (3) increased education in community-engaged methods for social and natural scientists working with Sami communities. This study supports the need for the development of formalized ethical protocols for conducting community-based engaged research with and for Sami people in Finland that ensure mutually beneficial research for all involved.
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http://dx.doi.org/10.1007/s13280-020-01459-wDOI Listing
January 2021

Ethical considerations for community-based participatory research with Sami communities in North Finland.

Ambio 2021 Jan 16. Epub 2021 Jan 16.

Montana State University, 318C Herrick Hall, Bozeman, MT, 59717-3540, USA.

This study examines the perspectives of Sami community members and university researchers regarding the ethical considerations for engagement in Community-Based Participatory Research (CBPR) with Sami communities in northern Finland. Key informant interviews were conducted with Sami people from Finland who were exposed to or participated in research in their communities as well as with researchers who have conducted research with the Sami in Finland across diverse topics. Five themes were identified: establishing trust, research preparation, research comprehension, research ethics, and inclusion in research. The differences in participant perspectives were compared based on their community versus researcher roles. Our findings emphasize the need for (1) strategies to develop and maintain trust between Sami communities and researchers; (2) methods to bridge concepts of bias projected onto Sami communities and researchers by the others' differing world views and beliefs about research; and (3) increased education in community-engaged methods for social and natural scientists working with Sami communities. This study supports the need for the development of formalized ethical protocols for conducting community-based engaged research with and for Sami people in Finland that ensure mutually beneficial research for all involved.
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http://dx.doi.org/10.1007/s13280-020-01459-wDOI Listing
January 2021

Effect of Advance Care Planning on Surrogate Decision Makers' Preparedness for Decision Making: Results of a Mixed-Methods Randomized Controlled Trial.

J Palliat Med 2020 Dec 29. Epub 2020 Dec 29.

College of Medicine, Penn State University, Hershey, Pennsylvania, USA.

Advance care planning (ACP) is intended to help patients and their spokespersons prepare for end-of-life decision making, yet little is known about what factors influence the extent to which spokespersons feel prepared for that role. To examine spokespersons' perceived preparedness for surrogate decision making after engaging in ACP. Mixed methods experimental design with qualitative thematic analysis and data transformation (creating categorical data from rich qualitative data) of interviews collected during a randomized controlled trial (2012-2017). Two tertiary care medical centers (Hershey, PA and Boston, MA). Of 285 dyads (patients with advanced illness and their spokespersons) enrolled in the trial, 200 spokesperson interviews were purposively sampled and 198 included in the analyses. Interviews with spokespersons (four weeks post-intervention) explored spokespersons' perceived preparedness for surrogate decision making, occurrence of ACP conversations, and spokespersons' intentions regarding future surrogate decisions. Data transformation was used to categorize participants' responses into three categories: , , or . Themes and categories were compared across arms. About 72.72% of spokespersons (144/198) reported being and 27.28% (54/198) reported being or with no differences in preparedness across study arms. Occurrence of post-intervention ACP conversations did not influence perceived preparedness; however, spokespersons who used an ACP decision aid reported more conversations. Four themes emerged to explain spokespersons' perceived preparedness: (1) perceptions about ACP; (2) level of comfort with uncertainty; (3) relational issues; and (4) personal characteristics. Regarding future intentions, it emerged that spokespersons believed their knowledge of patient wishes, as well as other personal, relational, situational, and emotional factors would influence their surrogate decisions. Factors extrinsic to specific ACP interventions influence how prepared spokespersons feel to act as spokespersons. Understanding these factors is important for understanding how to improve concordance between patients' stated end-of-life wishes and surrogate decisions. NCT02429479.
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http://dx.doi.org/10.1089/jpm.2020.0238DOI Listing
December 2020

Gratitude in the Time of Corona.

Authors:
Rhonda M Johnson

Int J Circumpolar Health 2020 12;79(1):1852814

Editor-in-Chief, (2015-).

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http://dx.doi.org/10.1080/22423982.2020.1852814DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7733956PMC
December 2020

Surrogate Decision Maker Stress in Advance Care Planning Conversations: A Mixed-Methods Analysis From a Randomized Controlled Trial.

J Pain Symptom Manage 2020 12 6;60(6):1117-1126. Epub 2020 Jul 6.

Department of Humanities, Penn State College of Medicine, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA; Department of Medicine, Penn State College of Medicine, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA; Public Health Sciences at Penn State College of Medicine, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA.

Context: Spokespersons serving as surrogate decision makers for their loved ones report high levels of stress. Despite known benefits, advance care planning (ACP) conversations often do not occur. More information is needed to understand spokesperson stress during ACP.

Objectives: To explore if and how spokespersons perceive stress related to ACP conversations; compare factors related to stress; and assess whether ACP intervention impacted stress.

Methods: Secondary and mixed-methods analysis with data transformation of semistructured interviews occurring during a 2 × 2 factorial (four armed) randomized controlled trial that compared standard online ACP to a comprehensive online ACP decision aid. Tools were completed by patients with advanced illness (n = 285) alone or with their spokesperson (n = 285). About 200 spokesperson interviews were purposively sampled from each of the four arms (50 per arm).

Results: ACP conversations were reported as stressful by 54.41% (74 of 136) and nonstressful by 45.59% (62 of 136). Five themes impacting spokesperson stress were the nature of the relationship with their loved one; self-described personality and belief systems; knowledge and experience with illness and ACP conversations; attitude toward ACP conversations; and social support in caregiving and decision making. No significant differences in stress were associated with arm assignment.

Conclusion: Identifying what factors impact spokesperson stress in ACP conversations can be used to help design ACP interventions to more appropriately address the needs and concerns of spokespersons.
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http://dx.doi.org/10.1016/j.jpainsymman.2020.07.001DOI Listing
December 2020

Editorial.

Authors:
Rhonda M Johnson

Int J Circumpolar Health 2019 12;78(1):1690793

Editor-in-Chief, International Journal of Circumpolar Health.

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http://dx.doi.org/10.1080/22423982.2019.1690793DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7595350PMC
December 2019

A Novel Approach to Improve Health Literacy in Immigrant Communities.

Health Lit Res Pract 2019 Jul 3;3(3 Suppl):S15-S24. Epub 2019 Oct 3.

Background: Anchorage, Alaska, has a large immigrant and refugee population. In fact, it is one of the most ethnically diverse cities in the United States with almost 100 languages spoken by children in the public school system. The city's immigrant and refugee population speaks limited English, and most of these residents are unfamiliar with where or how to obtain health care services through the American health care system.

Brief Description Of Activity: We developed a peer language navigator (PLN) program.

Implementation: The Anchorage Health Literacy Collaborative developed a community-wide program to address the health literacy needs of the city's immigrant and refugee population. Select people who attended Anchorage's adult literacy program (the Alaska Literacy Program) were chosen to learn about health and wellness topics as well as how to obtain health information from reliable online sources. These people, initially known as PLNs, were then trained to share health information resources with their respective communities.

Results: A recent evaluation of the program using ripple effects mapping showed that the program has demonstrated wide success, providing understandable health information to hundreds of new English learners throughout the area and guiding them to reliable health and wellness information they can use for themselves, their families, and their community. PLNs have become leaders in their communities and have been renamed peer leader navigators.

Lessons Learned: For similar programs to be successful, PLNs should be trained using adult learning principles, allowing them to focus on topics and issues of interest to them. The program should link with community organizations to extend the reach of the program. Care must be exercised to avoid overextending or overwhelming PLNs because after they become leaders in their communities, they will receive many requests to provide guidance and education. Finally, when possible, PLNs should be compensated so they can more fully devote their efforts to serving the community. .

Plain Language Summary: The Anchorage Health Literacy Collaborative in Alaska developed a program in which immigrant and refugees attending the city's adult education program to learn beginning English are chosen to serve as peer language navigators (PLNs). The PLNs learn how to obtain credible and easy-to-understand health information and then share it with their respective cultural communities. Lessons learned over time are shared.
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http://dx.doi.org/10.3928/24748307-20190408-01DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6826755PMC
July 2019

Using the distress thermometer to guide electronic referrals to psychosocial services.

J Psychosoc Oncol 2020 Jan-Feb;38(1):20-35. Epub 2019 Jul 15.

Saint Luke's Health System, Saint Luke's Cancer Institute, Kansas City, MO, USA.

Evaluate a new administration protocol of the distress thermometer (DT) and assess its use in guiding electronic referrals within the medical record. Data were gathered as part of a quality improvement project. Any patient within Saint Luke's Cancer Institute from March of 2016 to December of 2017. The DT was administered at every appointment with surgical and medical oncology and on Mondays while completing radiation. A referral to supportive services was offered to any patient scoring a 4 or above. Referrals to all supportive services increased by 69%. Staff adherence to distress screening guidelines increased to 95.42% and patient refusal to accept referrals fell to 2.72%. Administering the DT on a more regular basis and utilizing the DT to guide electronic referrals is achievable and results in increased referrals to supportive services. Utilizing the DT in this manner can increase the number of patients identified and treated for distress.
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http://dx.doi.org/10.1080/07347332.2019.1631932DOI Listing
February 2021

Using the distress thermometer to guide electronic referrals to psychosocial services.

J Psychosoc Oncol 2020 Jan-Feb;38(1):20-35. Epub 2019 Jul 15.

Saint Luke's Health System, Saint Luke's Cancer Institute, Kansas City, MO, USA.

Evaluate a new administration protocol of the distress thermometer (DT) and assess its use in guiding electronic referrals within the medical record. Data were gathered as part of a quality improvement project. Any patient within Saint Luke's Cancer Institute from March of 2016 to December of 2017. The DT was administered at every appointment with surgical and medical oncology and on Mondays while completing radiation. A referral to supportive services was offered to any patient scoring a 4 or above. Referrals to all supportive services increased by 69%. Staff adherence to distress screening guidelines increased to 95.42% and patient refusal to accept referrals fell to 2.72%. Administering the DT on a more regular basis and utilizing the DT to guide electronic referrals is achievable and results in increased referrals to supportive services. Utilizing the DT in this manner can increase the number of patients identified and treated for distress.
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http://dx.doi.org/10.1080/07347332.2019.1631932DOI Listing
February 2021

Editorial.

Authors:
Rhonda M Johnson

Int J Circumpolar Health 2018 12;77(1):1557879

a Editor-in-chief University of Alaska Anchorage.

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http://dx.doi.org/10.1080/20008686.2018.1557879DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7011870PMC
December 2018

Traditional Food Practices, Attitudes, and Beliefs in Urban Alaska Native Women Receiving WIC Assistance.

J Nutr Educ Behav 2019 03 6;51(3):318-325. Epub 2018 Nov 6.

Center for Alaska Native Health Research and Institute of Arctic Biology, University of Alaska Fairbanks, Fairbanks, AK. Electronic address:

Objective: To identify practices, attitudes, and beliefs associated with intake of traditional foods among Alaska Native women.

Design: Cross-sectional study that measured traditional food intake; participation in food-sharing networks; presence of a hunter or fisherman in the home; the preference, healthfulness, and economic value of traditional foods; and financial barriers to obtaining these foods.

Participants: Purposive sample of 71 low-income Alaska Native women receiving Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) assistance in Anchorage, AK.

Analysis: Bivariate and multivariate regression analyses.

Results: Traditional foods contributed 4% of total daily calories. Given a choice, 63% of participants indicated that they would prefer half or more of the foods they ate to be traditional (ie, not store-bought). The majority of participants (64%) believed that traditional foods were healthier than store-bought foods. Of all participants, 72% relied on food-sharing networks for traditional foods; only 21% acquired traditional foods themselves. Participants who ate more traditional foods preferred traditional foods (B = .011 P = .02).

Implications For Research And Practice: Traditional food intake was low and findings suggested that Alaska Native women living in an urban setting prefer to consume more but are unable to do so. Future research might examine the effect of enhancing social networks and implementing policies that support traditional food intake.
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http://dx.doi.org/10.1016/j.jneb.2018.09.003DOI Listing
March 2019

A scoping review of traditional food security in Alaska.

Int J Circumpolar Health 2018 12;77(1):1419678

a Department of Biology & Wildlife , University of Alaska Fairbanks , Fairbanks , AK , USA.

Background: Food insecurity is a public health concern. The pillars of food security include food access, availability and utilisation. For some indigenous peoples, the pillars may focus on traditional foods.

Objective: To conduct a scoping review on traditional foods and food security in Alaska.

Design: Google Scholar and the High North Research Documents were used to search for relevant primary research using the following terms: “traditional foods”, “food security”, “access”, “availability”, “utilisation”, “Alaska”, “Alaska Native” and “indigenous”.

Results: Twenty four articles from Google Scholar and four articles from the High North Research Documents met the inclusion criteria. The articles revealed three types of research approaches, those that quantified traditional food intake (n=18), those that quantified food security (n=2), and qualitative articles that addressed at least one pillar of food security (n=8).

Conclusions: Studies that estimate the prevalence of traditional food insecurity in Alaska are virtually absent from the literature. Instead most studies provide a review of factors related to food security. Research investigating dietary intake of traditional foods is more prevalent. Future research should include direct measurements of traditional food intake and food security to provide a more complete picture of traditional food security in Alaska.
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http://dx.doi.org/10.1080/22423982.2017.1419678DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5757232PMC
December 2018

The 10th GCC Closed Forum: rejected data, GCP in bioanalysis, extract stability, BAV, processed batch acceptance, matrix stability, critical reagents, ELN and data integrity and counteracting fraud.

Bioanalysis 2017 Apr 24;9(7):505-516. Epub 2017 Mar 24.

WuXi Apptec, Plainsboro, NJ, USA.

The 10th Global CRO Council (GCC) Closed Forum was held in Orlando, FL, USA on 18 April 2016. In attendance were decision makers from international CRO member companies offering bioanalytical services. The objective of this meeting was for GCC members to meet and discuss scientific and regulatory issues specific to bioanalysis. The issues discussed at this closed forum included reporting data from failed method validation runs, GCP for clinical sample bioanalysis, extracted sample stability, biomarker assay validation, processed batch acceptance criteria, electronic laboratory notebooks and data integrity, Health Canada's Notice regarding replicates in matrix stability evaluations, critical reagents and regulatory approaches to counteract fraud. In order to obtain the pharma perspectives on some of these topics, the first joint CRO-Pharma Scientific Interchange Meeting was held on 12 November 2016, in Denver, Colorado, USA. The five topics discussed at this Interchange meeting were reporting data from failed method validation runs, GCP for clinical sample bioanalysis, extracted sample stability, processed batch acceptance criteria and electronic laboratory notebooks and data integrity. The conclusions from the discussions of these topics at both meetings are included in this report.
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http://dx.doi.org/10.4155/bio-2017-5000DOI Listing
April 2017

Significance of Nonphysical Predictors of Distress in Cancer Survivors.

Clin J Oncol Nurs 2016 Oct;20(5):E112-7

University of Central Arkansas.

Background: The Distress Thermometer (DT) is a well-validated tool that is frequently used in patients with cancer to screen for general distress and to generate referrals. However, a majority of the DT problem list items relate to physical concerns; this may lead to psychosocial issues being overshadowed.

Objectives: The purpose of the current study is to examine the endorsement rates for nonphysical items, as well as the relationship between these items and overall DT scores.

Methods: A multiple logistic regression analysis of the first-time distress rating scale of 1,209 patients from 2005-2009 was conducted to determine whether nonphysical items on the DT significantly contributed to a patient falling into one of two categories.

Findings: This study provides evidence that emotional variables are particularly significant for patients who are at risk for distress and, consequently, should be prioritized for intervention when endorsed on the DT problem list.
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http://dx.doi.org/10.1188/16.CJON.E112-E117DOI Listing
October 2016

Use of archival data on Indian residential schools.

Int J Circumpolar Health 2016 27;75:32591. Epub 2016 Jun 27.

International Journal of Circumpolar Health, University of Alaska Anchorage, Anchorage, AK, USA;

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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4926101PMC
http://dx.doi.org/10.3402/ijch.v75.32591DOI Listing
June 2016

Cognitive function during and six months following chemotherapy for front-line treatment of ovarian, primary peritoneal or fallopian tube cancer: An NRG oncology/gynecologic oncology group study.

Gynecol Oncol 2015 Dec 9;139(3):541-5. Epub 2015 Oct 9.

University of Arizona Cancer Center, Tucson, AZ, United States. Electronic address:

Objectives: Changes in cognitive function have been identified in and reported by many cancer survivors. These changes have the potential to impact patient quality of life and functional ability. This prospective longitudinal study was designed to quantify the incidence of change in cognitive function in newly diagnosed ovarian cancer patients throughout and following primary chemotherapy.

Methods: Eligible patients had newly diagnosed, untreated ovarian cancer and had planned to receive chemotherapy. Web-based and patient reported cognitive assessments and quality of life questionnaires were conducted prior to chemotherapy, prior to cycle four, after cycle six, and six months after completion of primary therapy.

Results: Two-hundred-thirty-one evaluable patients entered this study between May 2010 and October 2011. At the cycle 4 time point, 25.2% (55/218) of patients exhibited cognitive impairment in at least one domain. At the post-cycle 6 and 6-month follow up time points, 21.1% (44/208) and 17.8% (30/169) of patients, respectively, demonstrated impairment in at least one domain of cognitive function. There were statistically significant, but clinically small, improvements in processing speed (p<0.001) and attention (p<0.001) but not in motor response time (p=0.066), from baseline through the six-month follow up time period.

Conclusions: This was a large, prospective study designed to measure cognitive function in ovarian cancer. A subset of patients had evidence of cognitive decline from baseline during chemotherapy treatment in this study as measured by the web-based assessment; however, changes were generally limited to no more than one domain.
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http://dx.doi.org/10.1016/j.ygyno.2015.10.003DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4698796PMC
December 2015

A Process Evaluation of the Alaska Native Colorectal Cancer Family Outreach Program.

Health Educ Behav 2016 Feb 8;43(1):35-42. Epub 2015 Jul 8.

Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Albuquerque, NM, USA.

This article presents the results of a process evaluation of the Alaska Native (AN) Colorectal Cancer (CRC) Family Outreach Program, which encourages CRC screening among AN first-degree relatives (i.e., parents, siblings, adult children; hereafter referred to as relatives) of CRC patients. Among AN people incidence and death rates from CRC are the highest of any ethnic/racial group in the United States. Relatives of CRC patients are at increased risk; however, CRC can be prevented and detected early through screening. The evaluation included key informant interviews (August to November 2012) with AN and non-AN stakeholders and program document review. Five key process evaluation components were identified: program formation, evolution, outreach responses, strengths, and barriers and challenges. Key themes included an incremental approach that led to a fully formed program and the need for dedicated, culturally competent patient navigation. Challenges included differing relatives' responses to screening outreach, health system data access and coordination, and the program impact of reliance on grant funding. This program evaluation indicated a need for more research into motivating patient screening behaviors, electronic medical records systems quality improvement projects, improved data-sharing protocols, and program sustainability planning to continue the dedicated efforts to promote screening in this increased risk population.
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http://dx.doi.org/10.1177/1090198115590781DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4706499PMC
February 2016

Changing of the guards.

Int J Circumpolar Health 2015 6;74:28917. Epub 2015 Jul 6.

University of Alaska Anchorage, Anchorage, AK, USA.

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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4495622PMC
http://dx.doi.org/10.3402/ijch.v74.28917DOI Listing
November 2016

The Relationship Between Perceived Racism/Discrimination and Health Among Black American Women: a Review of the Literature from 2003 to 2013.

J Racial Ethn Health Disparities 2015 Mar;2(1):11-20

Objectives: The purpose of this paper was to systematically review the literature investigating the relationship between perceived racism/discrimination and health among black American women.

Methods: Searches for empirical studies published from January 2003 to December 2013 were conducted using PubMed and PsycInfo. Articles were assessed for possible inclusion using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2009 framework. In addition, the Agency for Healthcare Research and Quality (AHRQ) system for rating the strength of scientific evidence was used to assess the quality of studies included in the review.

Results: Nineteen studies met criteria for review. There was mixed evidence for general relationships between perceived racism/discrimination and health. Consistent evidence was found for the relationship between adverse birth outcomes, illness incidence, and cancer or tumor risk and perceived racism/discrimination. Inconsistent findings were found for the relationship between perceived racism/discrimination and heart disease risk factors. There was no evidence to support the relationship between perceived racism/discrimination and high blood pressure.

Conclusions: There is mixed evidence to support the association between perceived racism/discrimination and overall objective health outcomes among black American women. The strongest relationship was seen between perceived racism/discrimination and adverse birth outcomes. Better understanding of the relationship between health and racism/discrimination can aid in identifying race-based risk factors developing primary prevention strategies. Future studies should aim to investigate the role of perceived racism/discrimination as a specific chronic stressor within discrete pathogenesis models.
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http://dx.doi.org/10.1007/s40615-014-0043-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4426269PMC
March 2015

Outcomes of a Seven Practice Pilot in a Pay-For-Performance (P4P)-Based Program in Pennsylvania.

J Racial Ethn Health Disparities 2015 Mar;2(1):139-48

Highmark Health Equity Quality Consultant; NIH NCI CRCHD K01 grantee; and Adjunct Assistant Professor of Public Health Sciences, and Biobehavioral Health at The Pennsylvania State University, Milton S. Hershey Medical Center, College of Medicine, Hershey, Pennsylvania, 100 Senate Avenue, Suite SP6N Camp Hill, PA 17011.

Objectives: The objective of this study was to examine how targeted six-month interventions impacted Best Practice/Patient Outcomes for minority patients receiving primary care in physician practices participating in a pay-for-performance (P4P) program.

Methods: P4P Practices were invited to participate in a pilot intervention study designed to improve care for minority patients with hypertension, diabetes or pediatric asthma. Patient medical records were reviewed to assess how the interventions impacted (n=7 practices): Body mass index, diet and exercise, smoking, compliance with visits as recommended, blood pressure, sodium intake and weight management counseling, medication reconciliation, HbA1c testing, annual lipid profile, and anti-inflammatory medications.

Results: Significant improvements in various clinical quality measures were observed in all seven practices. Of the 19 specified interventions, 13 were statistically significant at α=0.05 level and 14 met the target proportion. This suggests that the best practice intervention had a significant impact on some of the health care processes in the physician practices.

Conclusions: The most impactful interventions were those related to face-to-face educational discussions, patient medical chart documentations rather than those pertaining to medication adherence. Improvements in measuring reporting and recording of data at post-intervention were also observed.
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http://dx.doi.org/10.1007/s40615-014-0057-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4399862PMC
March 2015

Consuming untreated water in four southwestern Alaska Native communities: reasons revealed and recommendations for change.

J Environ Health 2014 Dec;77(5):8-13; quiz 52

In this article, the authors provide the first in-depth account of why some Alaska Native people drink untreated water when treated water is available. Their qualitative research was conducted in four Alaska Native village communities that have treated water available from a centralized distribution point. Most respondents (n = 172; 82%) reported that some of their household's drinking water came from an untreated source. Motives for drinking untreated water emerged from analysis of open-ended questions about drinking water practice and could be categorized into six themes: chemicals, taste, health, access, tradition, and cost. Importantly, some residents reported consuming untreated water because they both liked untreated water and disliked treated water. As such, interventions to increase safe water consumption should address this dichotomy by providing education about the benefits of treated water alongside the risks involved with drinking untreated water. Based on the findings, the authors provide specific recommendations for developing behavior change interventions that address influences at multiple social-ecological levels.
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December 2014

An analysis of the distress thermometer problem list and distress in patients with cancer.

Support Care Cancer 2015 May 16;23(5):1225-32. Epub 2014 Oct 16.

University of Kansas Medical Center, 3901 Rainbow Blvd, Kansas City, KS, USA.

Purpose: Patients with a cancer diagnosis experience complex issues that can cause distress. The purpose of this study is to identify factors associated with overall distress for a diverse population of cancer survivors.

Methods: Researchers conducted a secondary data analysis of distress ratings (n = 1205) for people receiving outpatient care at a Midwestern US cancer center from 2005 to 2009 to describe the relationships between distress factors and need for assessment of distress. The screening tool was based on the distress thermometer (DT) scale and a modified problem list. Odds ratios and 95 % confidence intervals from this multivariable model were computed.

Results: Statistical analysis revealed that the items on the problem list that most contribute to being at risk for distress include financial, worry, nervousness, getting around, and sleep. The most highly associated risk factor for distress was worry. Those that were at risk for high distress were 5.57 times more likely to endorse problems related to worry.

Conclusions: This research identifies which factors may be especially salient to the patient's perception of distress and help guide clinicians in developing targeted screening strategies and specific interventions based on patient response to the DT. It also points to the need for future research to more clearly characterize distress from the patient perspective and determine when interventions may be indicated.
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http://dx.doi.org/10.1007/s00520-014-2471-1DOI Listing
May 2015

Examining DNA fingerprinting as an epidemiology tool in the tuberculosis program in the Northwest Territories, Canada.

Int J Circumpolar Health 2013 8;72. Epub 2013 May 8.

Health Sciences, University of Alaska, Anchorage, AK, USA.

Background: Tuberculosis (TB) is an important public health problem in the Northwest Territories (NWT), particularly among Canadian Aboriginal people.

Objective: To analyse the transmission patterns of tuberculosis among the population living in the NWT, a territorial jurisdiction located within Northern Canada.

Methods: This population-based retrospective study examined the DNA fingerprints of all laboratory confirmed cases of TB in the NWT, Canada, between 1990 and 2009. An isolate of each lab-confirmed case had genotyping done using IS6110 Restriction Fragment Length Polymorphism. DNA patterns were assigned to each DNA fingerprint, and indistinguishable fingerprints patterns were assigned a cluster. Social network analysis (SNA) was used to examine direct linkages among cases determined through conventional contact tracing (CCT), their DNA fingerprint and home community.

Results: Of the 225 lab-confirmed cases identified, the study was limited to 195 subjects due to DNA fingerprinting data availability. The mean age of the cases was 43.8 years (±22.6) and 120 (61.5%) males. The Dene (First Nations) encompassed 120 of the cases (87.7%), 8 cases (4.1%) were Inuit, 2 cases (1.0%) were Metis, 7 cases (3.6%) were Immigrants and 1 case had unknown ethnicity. One hundred and eighty six (95.4%) subjects were clustered, resulting in 8 clusters. Trend analysis showed significant relationships between with risk factors for unemployment (p=0.020), geographic location (p≤0.001) and homelessness (p≤0.001). Other significant risk factors included excessive alcohol consumption, prior infection with Mycobacterium tuberculosis and prior contact with a case of TB.

Conclusions: This study demonstrates how DNA fingerprinting and SNA can be additional epidemiological tools, along with CCT method, to determine transmission patterns of TB.
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http://dx.doi.org/10.3402/ijch.v72i0.20067DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3650219PMC
January 2014

Cancer-related fatigue.

Am J Nurs 2012 Apr;112(4):57-60

University of Kansas Medical Center in Kansas City, KS, USA.

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http://dx.doi.org/10.1097/01.NAJ.0000413462.26668.96DOI Listing
April 2012

Circumpolar health collaborations: a description of players and a call for further dialogue.

Int J Circumpolar Health 2011 2;70(5):576-83. Epub 2011 Nov 2.

Institute for Circumpolar Health Research, Yellowknife, NT, X1A 3X7, Canada.

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http://dx.doi.org/10.3402/ijch.v70i5.17850DOI Listing
May 2012

Pan-Arctic TV Series on Inuit wellness: a northern model of communication for social change?

Int J Circumpolar Health 2011 Jun 27;70(3):236-44. Epub 2011 Jun 27.

Department of Health Sciences, University of Alaska Anchorage, Anchorage, AK 99508-4614, USA.

Objectives: This paper provides highlights of a utilization-focused evaluation of a collaborative Pan-Arctic Inuit Wellness TV Series that was broadcast live in Alaska and Canada in May 2009. This International Polar Year (IPY) communication and outreach project intended to (1) share information on International Polar Year research progress, disseminate findings and explore questions with Inuit in Alaska, Canada and Greenland; (2) provide a forum for Inuit in Alaska, Canada and Greenland to showcase innovative health and wellness projects; (3) ensure Inuit youth and adult engagement throughout; and (4) document and reflect on the overall experience for the purposes of developing and "testing" a participatory communication model.

Study Design: Utilization-focused formative evaluation of the project, with a focus on overall objectives, key messages and lessons learned to facilitate program improvement.

Methods: Participant observation, surveys, key informant interviews, document review and website tracking.

Results: Promising community programs related to 3 themes - men's wellness, maternity care and youth resilience - in diverse circumpolar regions were highlighted, as were current and stillevolving findings from ongoing Arctic research. Multiple media methods were used to effectively deliver and receive key messages determined by both community and academic experts. Local capacity and new regional networks were strengthened. Evidence-based resources for health education and community action were archived in digital formats (websites and DVDs), increasing accessibility to otherwise isolated individuals and remote communities.

Conclusions: The Pan-Arctic Inuit Wellness TV Series was an innovative, multi-dimensional communication project that raised both interest and awareness about complex health conditions in the North and stimulated community dialogue and potential for increased collaborative action. Consistent with a communication for social change approach, the project created new networks, increased motivation to act and provided new tools to do so, and increased local community involvement and "voice" in the discussion and dissemination of successful strategies to promote Inuit wellness.
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http://dx.doi.org/10.3402/ijch.v70i3.17827DOI Listing
June 2011